Objectives, results management, let alone profits, costs or budgets, all concepts related to economism or the introduction of corporate culture in health care management. Those who refer to the "corporate culture" are usually equivalent to the result, and they often result to victory, and of course, profit and health concepts are incompatible.

A hospital (1) is first of all an organization, ie, a human group made up of specialists working together on a project. Unlike "society", "community" or "family" - the traditional social aggregates - an organization intended purpose and is not based on the psychological nature of man or his biological need. Society, community, family are; organizations do. They know that they are productive (2). This is a crucial starting point in the reasoning will. After the organization can be public (owned, funded and managed by one of the territorial levels of public administration) and private for-profit (commercial company) or non-profit (foundation, partnership, mutual ...), but that it does is define who are the owners or holders, as it is financed and what to do with earnings, but does not change what is a substantial organization, the Joint knowledge the purpose and hence the result. A hospital is a joint project of many different professionals and applied scientific knowledge, has a purpose - to provide medical care and health - and has a result - providing it efficiently, generating resources for the future.

The need for organizations to achieve their results is that since the eighteenth century has shaped the field of knowledge that is now known as Management Sciences (3). The management by objectives (DPO) is one of the practices of management and there are references dating from 1916 (Fayol, Henri. Administration industrielle et générale. Bulletin of the Société de l'Industrie Minérale. 1916), but it was Peter Drucker who introduced the concept of Management by Objectives in 1954 in his book The Practice of Management, and did not from creativity but from practice and from the experience of growing companies like General Motors were and General Electric, the complexity of which was parallel to its size and needed to align business goals and objectives of the various units. At that time, although there was no concept of business strategy as we know it today - not until the seventies that they begin to talk - and then the purpose of the DPO was to coordinate the different functions of the organization, with concrete results, in order to meet the growing demand of the market expectations as sales existed.

The introduction of strategic management will focus on the market and be interested in competition and competitive advantage and will in some forgotten the DPO, which will be used, and often misused, according to the resources human in order to encourage variable remuneration systems that encourage employees and changing the focus initially was intended: to achieve the objectives of the organization results and reward their achievement vs.. variable compensation to motivate employees based on the objectives that justify.

It is from the late nineties until now that is becoming quite to the results via the concept of performance - Kaplan and Norton, Bossidy and Charan, Hamel - that is, integrating the concept of strategic management and the DPO to ensure that organizations that aspire to achieve it effectively.

So, going back a few lines to many, the hospital as a joint project with knowledge, with a purpose and to achieve a result, it seems logical to be given the tools that provides management and their major or less difficulty in doing so determined by the training - all can learn - but above all by the organizational culture, which can be changed - with time.

In the case of hospitals in the Public Hospital Network (PHN) of Catalonia - and of these let alone in public ownership - not used to thinking strategies linked to the performance or profitability, or growth of private organizations with their own profit - in other words companies - as they are in a situation typical monopsoni (4), being the consequence, then, can have only three possible, cater to the terms of the client: a strategy of efficiency, that is, be able to deliver what the customer asked, if they are effective, a strategy of efficiency, that is, in addition to fulfilling optimally apply resources and attempt to obtain a minimum gain of replacement, and if it is efficient, an excellent strategy • excellence, ie, maintaining the minimum gain reversal, aspiring to be a leader, able to teach and invest in research. To apply each of these strategies have to know what stage we need a good diagnosis, be realistic and start defining the different strategic objectives involving each. In the end, if we are ambitious, all want to be excellent but the concept of excellence • Excellence evolves in time, even now they have to approach challenges, and those farther n'estan will have different challenges. But all this, and this is most important for creating a project next to the professionals and give meaning to the center. If we do that work is just work, no need DPO's or professional careers, or the better salaries to motivate people. People want to project to know what is the meaning of what they do and why should make an effort when needed (5).

The DPO only makes sense from a strategic implementation allows us to know what must be achieved within a specific and see if it was so or not and what the consequences facing our purposes and the proposed the future.

Joseph Albet

Referring. Papers Union Foundation ( Original article pdf )

(1) Take the hospital as a reference for all known, but the reasoning can be applied to other health and social services.
(2) Drucker, P. (1993): Post-capitalist society. Harper Collins Publishers.
(3) To further the development of management see:
Wren, DA (2005): The History of Thought Manangement (Fifth Edition). John Wiley & Sons.
Nieto, J. (2005): Structure, Strategy and Knowledge. A historical reading of Policy Management. Doctoral thesis. Not published. ESADE.
(4) A single customer controls suppliers in terms of prices and quantities.
Those looking for other clients - insurance, mutual, private, ... - and reduce the dependence of this client are considering only do these strategies. The motivation to search for them or not, are different.
(5) To achieve sustainable organizational excellence:
"Senior executives must provide for clear roles within a structure matched to the needs of the business (accountability), articulate a compelling vision of the future (direction), and develop an environment encourages That Openness, trust and challenge (culture)." Leslie, K., Loch, MA, Schaninger, W. (2006): Managing your organization by the evidence. The McKinsey Quarterly, No. 3.

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